The recent article pubblished on JEMS “Deploying the Video Laryngoscope into a Ground EMS System” compare the success rate beetwen DL vs VL in a ground EMS Service. The device used was the King Vision with channeled blade. The partecipants had a quik training consisting in didactic orientation and practical skills on manikins.

The result of the study shown that “Within the first 100 days of the study, the video laryngoscope utilizing the channeled blade has shown to be at least as effective as DL in relation to first-attempt success” and considering that “the mean experience in our group with DL is nine years, yet the success rate remains unacceptable” “It’s time to consider transition from a skill that’s difficult to obtain and maintain to one that appears to have a quicker learning curve and will likely result in decreased episodes of multiple attempts at intubation and associated complications.”

So is direct laryngoscopy dead?( Or will be so in a few years)

Here is what I think

There are some fundamental differences in VL tecnique respect the DL tecnique, that makes the DL more intuitive to pass the tube trough the cords.

We have basically 3 main axis in the airways

When we manage the airways we first put the head in “sniffing position” aligning the pharyngeal axis with the laryngeal one

Then we use the laryngoscope to align the mouth axis having so a direct view of the cords. This view coincide with the way to pass the tube, making this step intitive and easy.

Using the videolaryngoscope we take our eyes right in front of the larynx, having a perfect “video” view of the vocal cords, but also minimally modifying the axis of the mouth.

For this reason passing the OTT is not straight forward, so we need the stylet, the Bougie/Froban or the external glottic maneuvers, to facilitate the intubation.

This difference in tecnique makes the VL a little tricky in sense of the contrast between the perfect laryngeal view and the not intuitive passage of the tube trogh the cords.

If you don’t use a stylet you need to apply some basics tricks. Visualaze the epiglottis first, stay in the vallecula with the blade as withe DL so you don’t lift the glottic plan. Now you don’t need a stylet. But why don’t using the stylet as we do routinelly?